Diagnosis and treatment of gallbladder stones, from asymptomatic forms to biliary colic and acute cholecystitis, with minimally invasive cholecystectomy when indicated.
Gallstone disease is a very common condition characterised by the formation of stones inside the gallbladder.
In many people the stones cause no symptoms at all and are found incidentally during an abdominal ultrasound.
When gallstones obstruct the normal flow of bile, they can cause
When stones become lodged in the bile duct (which connects the liver to the intestine), the following may occur:
When surgery is indicated, laparoscopic cholecystectomy is the most frequently used surgical approach.
The gallbladder is a small organ located beneath the liver.
Its main function is to collect and concentrate the bile produced by the liver and release it into the intestine during digestion, particularly after meals.
The formation of crystals within the bile can progressively lead to the development of one or more gallstones.
Gallbladder stones may be:
The mere presence of gallstones does not necessarily mean that surgery is required.
Asymptomatic gallstones are often discovered incidentally during:
In many patients without symptoms, clinical observation alone may be appropriate.
The most characteristic symptom of symptomatic gallstone disease is biliary colic.
Biliary colic is generally characterised by intense pain located in the upper right abdomen or in the epigastric region.
The pain may:
start after a meal;
radiate towards the back or the right shoulder;
last from several tens of minutes to a few hours;
be associated with nausea or vomiting.
An episode of biliary colic indicates that the stones are interfering with normal gallbladder function and makes a surgical assessment advisable.
Gallstones can cause certain complications that require urgent assessment.
When to seek urgent medical attention
Acute cholecystitis is an inflammation of the gallbladder that frequently occurs when a stone obstructs the cystic duct.
It may cause:
Unlike simple biliary colic, the pain of cholecystitis tends to be more persistent.
A stone can migrate from the gallbladder into the main bile duct, the common bile duct.
This is known as choledocholithiasis.
It may cause:
In these cases, further tests and possibly endoscopic procedures (ERCP) may be needed before or in combination with surgery.
Cholangitis is an infection of the bile ducts and is a potentially serious condition.
The presence of fever, abdominal pain and jaundice requires urgent medical assessment.
A small stone can migrate from the gallbladder and cause a transient obstruction near the outlet of the pancreas, resulting in acute gallstone pancreatitis.
This condition also requires hospital assessment.
Abdominal ultrasound is the initial reference examination for identifying gallbladder stones.
It can also provide information on:
When symptoms are present, the following may be assessed:
When stones in the bile ducts are suspected, magnetic resonance cholangiopancreatography (MRCP) or, in selected cases, other diagnostic or endoscopic investigations may be indicated.
The presence of stones is not automatically an indication for surgery.
Surgery is generally considered mainly in the presence of:
Treatment is therefore decided on the basis of symptoms and the risk of complications, not simply on the presence of stones on ultrasound.
Cholecystectomy is the removal of the gallbladder containing the stones.
In most elective cases the operation can be performed using a laparoscopic technique.
Through 3 or 4 small abdominal access points, the following are introduced:
The gallbladder is then separated from the liver and removed together with the stones.
Stone formation depends on the environment inside the gallbladder.
Removing only the stones while leaving the gallbladder in place would therefore not eliminate the mechanism responsible for their formation, so the entire gallbladder is removed.
The liver continues to produce bile normally after cholecystectomy.
The main difference is that bile is no longer stored in the gallbladder but flows directly from the liver to the intestine through the bile ducts.
A normal diet is resumed after the postoperative period.
Acute cholecystitis may require hospital admission and surgical treatment during the same clinical episode.
Emergency cholecystectomy can also be performed laparoscopically.
The treatment strategy, however, depends on:
duration of symptoms;
severity of inflammation;
general condition;
presence of systemic infection;
any stones in the bile ducts
In some complex patients a different strategy may be required.
The postoperative course depends on the patient's condition and on the complexity of the operation.
After an uncomplicated laparoscopic cholecystectomy, the following are generally planned:
Length of stay and recovery times are determined individually.
A specialist assessment is advisable in the presence of:
Having gallstones does not necessarily mean that surgery is needed.
A surgical consultation makes it possible to distinguish asymptomatic forms from those with an indication for treatment and to assess whether laparoscopic cholecystectomy can be performed.
No. Asymptomatic gallstones are not automatically an indication for surgery. The decision depends on symptoms and on the patient's clinical characteristics.
The most typical symptom is biliary colic, characterised by pain in the upper abdomen, often associated with nausea or vomiting.
When surgery is indicated, it is not just the stones that are removed: the gallbladder itself is removed through an operation called cholecystectomy.
Yes. Laparoscopic cholecystectomy is performed through small abdominal access points, except in situations where a different approach is required.
Yes. The liver continues to produce bile, which reaches the intestine directly through the bile ducts.
Yes. Acute cholecystitis may require hospital admission and surgical treatment during the acute episode, depending on the patient's clinical condition.
Severe and persistent pain, fever, jaundice, significant vomiting or a deterioration in general condition require prompt medical assessment.